A high incidence of severe CIP persisting until the day of discharge from the ICU was related to gram-negative sepsis but not to MOF alone. Retrospective chart analysis suggested that early application of IVIG may prevent or mitigate this severe complication. However, these results have to be confirmed in a prospective, placebo-controlled study.
Phenheptamethylen und einige andere V e r b i n d u n g e n der Phenheptamethylen-Gruppe. [.\us dem Allgemeinen Chemischen lnstitut der Uoiversittit GBttingen.] (Eingegangen am 4. Noveiiiber 1920.) Das Reduktionsverfahren von C l e m m e n s e n , das in den letzteu Jahren so vielfach benutzt worden ist, um Ketone in die zugehijrigen l~o h l e n w a s s e r~~o f~e zu verwandeln, hat es uns jetzt auch ermoglicbt, ohne allzu groBen Materialadwand das bisher noch unbekannte Rioghornologe des Tetrahydro-naphthalins (I.
In clinical practice, the administration of supplementary albumin often depends on the measured plasma concentration of total protein (TPC). A TPC of less than 5 g/dl is generally accepted as an indication for albumin therapy, assuming an albumin concentration of less than 2.5 g/dl. However, a physiological relation between TPC and albumin cannot be expected in critically ill patients, and thus, measurement of TPC may be misleading as an indicator for the use of albumin. Therefore, we investigated the sensitivity and specificity of TPC testing for diagnosing hypoalbuminaemia requiring treatment. METHODS. In this prospective study, 210 consecutive patients were included. Protein electrophoresis was performed three times a week; the second electrophoresis was selected for evaluation. Applied statistical analysis revealed the number of positive total protein tests indicating hypoalbuminaemia requiring treatment (sensitivity) and the number of negative with tolerable reduced albumin concentrations (specificity). RESULTS. Of the investigated patients, 27.6% had normal TPCs between 6.2 and 8.0 g/dl. In 81.9% of cases an albumin concentration below 3.5 g/dl was found, while 43 patients had a concentration below 2.5 g/dl. The sensitivity and specificity of TPC measurement for the diagnosis of clinically relevant hypoalbuminaemia (albumin concentration < 2.5 g/dl) was calculated at different cutoff points for total protein. With a TPC of 6.0 g/dl, the sensitivity was 0.96 and the specificity 0.44. With a cutoff point of 5.0 g/dl, the sensitivity was reduced to 0.65 and specificity increased to 0.86. Finally, with a TPC of 4.0 g/dl sensitivity was 0.25 and specificity almost 1. CONCLUSIONS. Depending on the cutoff point for TPC, a relevant albumin requirement would frequently not be detected. In other cases, a need for albumin would be assumed from a reduced TPC even though the albumin concentration still exceeded 2.5 g/dl. Therefore, determination of TPC is not a suitable indicator of the need for albumin replacement. As a result, we suggest routine determination of albumin concentrations instead of TPC.
Cdour Reaction of 3,5-Diacyl-2,6-heptanediones with Glyane Esters The 1.5-diketone 3 reacts with glycine esters at room temp. to yield the tetrahydroquinolines 5. At lower temp. the reaction stops at the stage of the N-alkylated 1,4-dihydropyridine (DHP) 4. 4 is also formed by the reaction of glycine esters with acetylacetone and formaldehyde in aqueous pyridine. Neither 4 nor 5 are identical with the product of the photometric assay from the colour rcaction of Pesez 2'3). The DHP 7 are obtained from the 1.5-dicarboxylic diestas 6. Das aus 1 mit NaH und Methyliodid erhaltene 1-MethylDerivat weist ein Absorptionsmaximum bei h = 377 nm auf7). Diese Tatsache spricht gegen die Annahme, da13 ein N-alkyliertes 1,4-DHP fiir das vermessene Maximum verantwortlich ist.Eine hplc Untersuchung des Reaktionsansatzes mit Glycin zeigte, da13 neben grof3en Mengen vieler im UV-Bereich absorbierender Produkte zwei Substanzen gebildet wurden, deren langwellige Maxima in den sichtbaren Bereich verschoben waren. Formaldehyd und Acetylaceton geben bereits mehrere
XI. A s s o z i a t i o n : Durch Versuch 9 wurde festgestellt, daS die zu hohen Werte furs Molekulargewicht des Rhodans, wie sie bei groDerer Konzentration gefunden werden, durch eine r e v e r s i b l e Assoziation bedingt sind. Eine 1.095-.n. Losung gab den zu hohen W e d 141'h; diese Liisung wurde durch Verdiinnen mit Hromoform 0.557-n. gemacht und gab dann den gleichen Wert 127'12 wie eine frisch bereitete Rhodanl6sung fast gleicher Konzentration (Versuch 7 b). Noch konzentriertere Liisungen als etwa 'I1-n. Losungen konnten nicht untersucht werden, da dann die Tension des Brnms bereits zu grol3 ist und Verluste an Brom eintreten. W. Borsche undA. Roth: Untersuchungen iibor die Bestandteile der Kawawurxel, 11. : aber daa Kawahars. [Aus dem Allgemeinen Chemischen Institnt der Universitiit Gottingen.] (Eingegangen om 30. Juli 1921.) Wenn man die Wurzel des Kawastrariches (Piper methysticum) mit Alkohol auszieht, bekommt man neben zwei schon krystallisierenden Stoffen, dem M e t h p s t i c i n , C H H I~O~, und dem Y a n g o n i n , ClsHlrO+ ein ziihflussiges, dunkelbraanes Haw, das B K a w a h a r z e, in einer Ausbeute von etwa 5 O / 0 des Rohmaterials, das a h wesentlicher Bestandteil des wertvollen Anti-gonorrhoicums 2 G on 0 s an* technisch gewonnen wird. M e t h y s t i c i n ist schon vor langerer Zeit von P o m e r a n z als Piperinoyl-essigsiiure-methylester (I.) kannt worden'), Y a n g o n i n von W. B o r s c h e und M a t h i l d e G e r h a r d t I ) hl. 9, 863 [18881. B. 47, 2902 [1914].
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